Health Check

Could your physical exam jeopardize your health in the field?

 
health check
POPTIKA/SHUTTERSTOCK.COM

“There are so many diseases and problems that have the potential to affect a commercial diver. Unfortunately, we see a lot of doctors across the country here doing diving physicals that haven’t been trained – and they don’t realize the potential hazard that can be,” says Tony Alleman, MD, MPH, Medical Director, Wound Care and Hyperbaric Center for Regional One Health.

 

Alleman understands everything about diver health because he is board certified in undersea and hyperbaric medicine in addition to occupational medicine. There are diseases out there, like seizure disorders, where some people should never dive, he explains. “I’ve seen unbelievable things from other doctors where they approve a patient fit to dive when they really shouldn’t.”

Required physicals are part of the vetting process for divers, much like in the military and institutional sports. There is a standard for commercial diving, the ADCI consensus standards. The problem is that very few physicians are aware of the standards and are able to apply the standards for evaluating commercial divers. “Unfortunately, there are not enough doctors around the country trained in diving to require divers get physicals from hyperbaric-certified physicians. So, therefore, they end up going to their general practitioner – whoever is going to sign the piece of paper.”

Where to Start

It’s clear better protocols and expectations for diver health need to be in place, and perhaps the best place to start is in school – before students choose their occupation pathway. “Schools do require physicals, but many aren’t hyperbaric certified,” says Phil Newsum, ADCI Executive Director.

But perhaps another issue, other than health risks, is the inability to find work in the field if you can’t pass a physical exam. “Students are graduating and not getting a job due to physical limitations underwater,” Newsum explains.

Schools should only accept students that have been examined according to ADCI Consensus Standards and by a physician that has been trained in the examination of commercial divers, Alleman says. “We have seen divers who come out of school that should have been disqualified before they even started school.”

Contractors are upset that schools aren’t requiring [follow-up] exams, Newsum explains. “Schools have a moral responsibility to lay out health protocols regarding the employment physical to the student – and document that discussion.”

Job Fitness

The ADCI Consensus Standards recommend physical examinations yearly (see checklist on this page). The Standards also lists medical requirements in Chapter 2, Part 3, and covers a variety of conditions that may indicate when someone is not fit for commercial diving. OSHA has diving regulations listed in 29 CFR 1910 Subpart T. While it does not specify physical requirements to be met by commercial divers, it does have a list of conditions in Appendix A that are disorders that may restrict or limit occupational exposure to hyperbaric conditions. These conditions include:

  • History of seizure disorder other than early febrile convulsions;
  • Malignancies (active) unless treated and without recurrence for 5 years;
  • Chronic inability to equalize sinus and/or middle ear pressure;
  • Cystic or cavitary disease of the lungs;
  • Impaired organ function caused by alcohol or drug use;
  • Conditions requiring continuous medication for control (e.g., antihistamines, steroids, barbiturates, mood-altering drugs, or insulin);
  • Meniere’s disease;
  • Hemoglobinopathies;
  • Obstructive or restrictive lung disease;
  • Vestibular end organ destruction;
  • Pneumothorax;
  • Cardiac abnormalities (e.g., pathological heart block, valvular disease, intraventricular conduction defects other than isolated right bundle branch block, angina pectoris, arrhythmia, coronary artery disease); and
  • Juxta-articular osteonecrosis.

Diving companies will often send divers to board-certified physicians who have taken the Undersea and Hyperbaric Medical Society (UHMS) course in examining divers for fitness, Alleman explains. This course is called the “Medical Examiner of Divers” and will be presented September 22-25 in New Orleans, LA. “Doctors attending this course will be added to a list on the UHMS website that indicates that they have successfully completed the course. It is recommended that companies use this list as a resource of finding physicians that have been trained in qualifying commercial divers for their work,” adds Alleman.

“Schools have a moral responsibility to lay out health protocols regarding the employment physical to the student – and document that discussion.”

Phil Newsum